General revision

• what is anaesthesia?

  The state of controlled and reversible unconsciourness characterised by lack of pain sensation (analgesia), lack of memory (amnesia) and relatively depressed reflex responses.
• What are the reasons for anaesthesia:

  Humanitarian.

  Prevent awareness of pain.

  Immobilisation of patient

  Legal, protection of animals act 1964.
• Advantages of general anaesthesia:

  • rapid loss of consciousness.
  • Facilitates surgical field.
  • Convenient
• Disadvantages of general anaesthesia:

  • Stressful restrain
• LA (topical)= desensitisation is produced only at or near site of application.
• Advantages of LA: No/little cardiovascular depression.
• ASA I: normal healthy patient
• ASA II: a patient with mild-systemic disease
• ASA III: a patient with moderate to severe systemic disease
• ASA IV: Patient with severe systemic disease that is a constant threat to life
• ASA V: A extreme risk and patient is not expected to survive.
• Aims of pre-meds:

  • Calm the patient
  • Reduce anxiety
  • Reduce amount of induction agent
  • reduce amount of maintenance agent
  • provides analgesia
• what occurs during induction of anaesthesia:

  • I/V catheter placement.
  • Endotracheal intubation.
  • monitor TPR
  • monitor level of consciousness
• Monitoring techniques- used to assess cardiovascular system.

  Observation- mm colour, CRT

  Palpate pulse- femoral, sublingual, carpal, auscultate heart

  Equipment- Pulse oximeter, oesophageal stethoscope, ECG
• Process for patient in respiratory arrest:

  1. Inform VS
  2. Ensure airway is patent
  3. Turn off vaporiser and flush O2 (only if patient is disconnected)
  4. Patient is on 100% O2
  5. Monitor pulse to ensure no cardiac arrest.
  6. manual (or automatic) IPPV 10 breaths per minute, continue monitoring vital signs.
  7. IV fluids and drugs used direction of VS
  8. Once vital signs have improved stop IPPV
• Process for patient with tachycardia

  1. nform VS and establish state of anaesthesia.
  2. What is it in relation to? hypotension? pain?
  3. Liase with surgeon
  4. Tachycardia may encourage arrhythmias
  5. may require use of drugs to reduce HR or increase depth of anaesthesia as determined by VS.